Healthcare Provider Details

I. General information

NPI: 1396664058
Provider Name (Legal Business Name): GALLERIE LYNCH BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14625 NE 23RD ST
CHOCTAW OK
73020-8728
US

IV. Provider business mailing address

13033 NE 9TH ST
CHOCTAW OK
73020-7331
US

V. Phone/Fax

Practice location:
  • Phone: 405-390-8131
  • Fax:
Mailing address:
  • Phone: 405-473-3443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: